Published on the Jan. 10, 2013, DiagnosticImaging.com website
By Whitney L.J. Howell
On January 1, the long-debated and much-opposed medical device tax went into effect. To date, medical device manufacturers have clearly stated their opposition, but industry leaders portend practicing radiologists also have reason to be concerned.
Barely a week old, this measure levies a 2.3 percent tax on all medical devices. The law calls for manufacturers to pay for the tax added to the sale price of the device, but many worry the cost will not only trickle down to providers, but will also, ultimately, stymy the progression of patient care by hindering research and development efforts.
“As radiologists, most of us chose the specialty because it’s a field that incentivizes technological innovation that can make enormous differences in patient care,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Economics Commission. “Payment or health care policies that would, in any way, negatively impact innovation are things that make us feel uncomfortable.”
The device tax will inevitably impact practitioners’ bottom lines, she said. The actual dollar amount is yet unknown, but manufacturers will be forced to pass some of the tax increase on to their customers. The price hike will likely be an unwelcome addition to existing imaging reimbursement cuts and the difficulties radiologists already face with collecting payments from patients. Equipment purchasing decisions could become more complicated or could be postponed, she said.
In addition to individual monetary concerns, radiologists should also worry about what the medical device tax could mean for their ability to provide the most up-to-date patient care. According to the Medical Imaging and Technological Alliance (MITA), this initiative is a job-killer because it makes outsourcing jobs overseas more attractive. But research and development efforts will also be a casualty, said MITA Executive Director Gail Rodriguez.
According to a recent MITA survey, 29 percent of manufacturers anticipate slicing into their research and development budgets as a way to cover the anticipated $287 million associated with the device tax. This change could leave providers without new technological innovations for treating patients, MITA said.
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2122393
Published on the Nov. 14, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
When CMS released its 2013 proposed Medicare payment cuts this month, no one in radiology was particularly surprised. Industry experts knew radiology settings and providers faced slashed reimbursement rates, and it’s now time for practices to assess just how affected they might be.
In the fee schedule, set for Jan. 1, 2013, implementation, CMS retained its proposed multiple procedure payment reduction (MPPR) of 25 percent to the professional component (PC) for CT, MRI, and ultrasound imaging conducted by one or more providers in the same practice on the same patient, during the same session, on the same day. The Medicare proposed cuts will also decrease overall payments to radiation therapy centers by 9 percent and reduce payments to radiation oncology providers by 7 percent.
Overall reaction, said Maurine S. Dennis, senior director of economics and health policy at the American College of Radiology, is that these proposed reductions are both arbitrary and complicated. The MPPR cut is creating significant angst, she said.
“It’s a cut — a cut to the professional component, so it’s real money out of our providers’ pockets,” she said. “The proposal deals a lot with subspecialists, and it’s complex. It’s going to take time to figure out how everything will shake out.”
The looming 25 percent MPPR cut isn’t the only problem, however, said Mike Mabry, executive director of the Radiology Business Management Association. CMS has also yet to publish any information or guidance about the new coding modifier it plans to implement for same-day, same-provider services. Currently, your coders use the -59 modifier to identify procedures done on the same day that are distinct from all others performed.
In addition, the agency has not released a definition for what it considers to be same-session, leaving practices to determine for themselves how best to process this type of claim. The best course of action, Mabry said, is for practices to conduct a self-assessment of how at-risk they are for MPPR PC payment cuts.
Practices that provide a higher level of tertiary care or other advanced diagnostic imaging services should conduct the most involved analyses of their same-day, same-session services. These settings, he said, will be the most vulnerable to the MPPR PC reduction and will feel the greatest impact on their bottom line.
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2114454
Published on the Oct. 23, 2012, Diagnostic Imaging website
By Whitney L.J. Howell
Connecticut launched its law mandating providers alert women if they have dense breasts and offer supplemental ultrasound screenings three years ago. The road has been rocky — radiologists initially resisted it, the density legislation confused many patients, and few women seemed interested in the secondary scans. But new research shows the law has resulted in more cancers found.
Much discussion surrounded Connecticut’s dense breast tissue law when it passed in 2009, requiring referring physicians to inform women with dense breast tissue that they could benefit from supplemental ultrasound screening. A recent study revealed the law had a slow, but effective, start.
In research published in the October issue of Radiology, investigators from Yale University determined less than 20 percent of women with dense breast tissue opted to have an ultrasound screening after receiving abnormal mammogram results. The retrospective review analyzed the ultrasound results for nearly 1,000 women who underwent the procedure.
Although fewer women than anticipated opted for ultrasound screenings after the law took effect, lead study author Regina Hooley, MD, assistant professor of diagnostic radiology, said giving patients the option of supplemental ultrasound screening after a mammogram was useful. Based on data pulled from the legislation’s first year, her team found additional 3.2 cancers per 1,000 women were discovered using ultrasound.
“These findings are right in the ballpark for the amount of cancers we identify with mammogram,” Hooley said. “Although mammography is the only test with data to show it reduces breast cancer-related mortality, it’s clear, with this study, that ultrasound provides an acceptable cancer detection rate at an acceptable cost.”
In January, Texas enacted its own version of the law, known as Henda’s Law. And, the American College of Radiology anticipated 13 additional states introducing some type of similar legislation during 2012.
According to the study’s cost analysis, each cancer identified via ultrasound cost approximately $60,000. That figure equals roughly $200 per patient, Hooley said. It’s also important to note that Connecticut insurance companies are required, under law, to cover these supplemental ultrasound screenings.
Connecticut radiologist Jean Weigert, MD, who serves as treasurer for the Radiological Society of Connecticut, also tracked supplemental ultrasound screenings in her practice. Her results, she said, are exactly the same as Hooley’s.
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/womens-imaging/content/article/113619/2110186
Published in the Sept. 17, 2012 Raleigh News & Observer and Charlotte Observer
By Whitney L.J. Howell
We asked Alex Roland, professor emeritus of history at Duke University, to put the current Mars Curiosity mission in a perspective. Roland is a former NASA historian.
Q: What are the benefits of unmanned space exploration, such as the Mars Curiosity?
One question has driven all current space exploration: Was there ever, or is there now, life on Mars? It’s likely if there were, it’s disappeared, but we might find evidence. That would have enormous implications for the space program and for the human race and condition. It would suggest we’re not unique in the universe.
Such a discovery would increase NASA’s emphasis on getting the country to agree to a manned Mars mission. NASA sees itself as having had a golden age with the Apollo program. Ever since, it has tried to find something else to capture public imagination to justify a large increase in our space activity spending. Curiosity plays an interesting role because if it finds evidence, NASA can increase its manned mission push. But Curiosity is such a capable exploration vehicle, and it’s so much cheaper and less dangerous than a manned mission, that many of us believe we should invest in more Curiosities.
Q: What’s the advantage of unmanned missions?
Whenever you send people to space, the expedition’s purpose changes. To explore Mars, we can send up as many remotely controlled vehicles as necessary. They’re uniquely designed for exploration. A manned mission must get people there and back safely. That trumps all else, and it limits exploration. Humans can only do safe exploration. Their exploration time is limited because they must return to Earth soon. It also limits the equipment sent up because astronauts need a lot of life support. For exploration, we’re better off sending custom-designed, remotely controlled, automated spacecraft. There’s nothing humans can do on Mars that a machine can’t. Sending people increases risk and diverts the mission’s goal.
Q: Are there potential technological gains from the Curiosity mission?
Investing in science and technology, especially research and development,
always produces spinoff. Second-order consequences and unanticipated technological applications can be useful in other fields. But that comes from any R&D. NASA’s spinoff record isn’t great. It has claimed the dollars it has invested produced more spinoff technology, but that mostly isn’t true. There’s nothing specific NASA does that makes R&D any more productive.
Q: Could this Mars mission be seen as a relaunch of space exploration?
Whenever I hear of manned Mars missions, my first question is, “Why?” What will we do? Will it be like Apollo where we send humans there and bring them home safely, and that’s the end?
NASA maintains manned Mars missions will be part of a permanent space colonization program. That begs the question of why colonize Mars? Sending humans there to take pictures, scoop soil, and return safely will cost hundreds of billions of dollars. An initial colonization mission would cost probably around $1 trillion just to get started.
So, it’s reasonable to ask the purpose and benefit of having people on Mars. A good comparison is the International Space Station. We paid more than $100 billion to put it up there and never found a good use for it. Within a decade, we’ll likely abandon it, let it decay in orbit, and burn up in the atmosphere. If we can’t find a good use for the space station that’s comparatively close and safe – even though we’ve lost two space shuttles and crews going there and back – how do we think we’ll find a good use for humans on Mars?
Q: What continues to drive NASA toward manned exploration? Are we still searching for our place or role in the universe?
That’s exactly it. When NASA sent the first crew to the space station, it stressed this reflected both the agency’s and our country’s place in history. It emphasized this was the beginning of permanent human space habitation. It believed from then on humans would be in space and people would look back and remember America, NASA, and the space program.
But there’s no commitment to fund the space station very far into the future. It’s too expensive to maintain, and it’s not doing anything useful.
NASA will argue strenuously to maintain a space presence. We all love NASA. We love what they do and think they’re good and capable. But the public has a right to ask what we’re getting for our investments, especially when budgets are stressed.
Q: In the last decade, space exploration has shifted from government-funded enterprise to the private sector. Will this continue?
I’ve long been skeptical that private companies without government subsidy can make money flying in space. There isn’t that much money to be made. It’s a big business, but it’s not what most private venture firms are motivated by. Often, it’s idealistic, very wealthy people with lots of money to invest.
They grew up in the space age. They want the same permanent space presence NASA wants, and they’re going to help make it happen. I think we’re seeing evidence they can build launch vehicles and operate them more cheaply than NASA. But do they have a business model for sustainable programs and making money?
None will reveal how much they’ve spent, and without long-term, sustainable business models, venture capital isn’t attracted. It’s unclear how many companies will make money.
NASA’s trying to help them because if companies assume routine activities, like launching satellites or resupplying the space station, then NASA can divert funding to futuristic enterprise, including manned Mars missions. Perhaps NASA has enough business to keep them going for a while, but not enough for long-term profit. One strange peculiarity of modern technology is the satellites we launch now are so big and powerful we don’t need as many of them as we used to.
Q: What can NASA do to reignite or reinvent itself?
What many at NASA only say privately is the public often doesn’t appreciate NASA’s unmanned spacecraft magnificence. It has transformed how we understand the universe and presented research possibilities, but NASA’s believed its public and congressional support and budget depend on manned space exploration.
NASA has believed people don’t care about space science, communication and weather satellites. But these technologies give us today’s world. Manned space flight has been little more than circus or stunt. Astronauts go up, float around, and return without accomplishing much.
Curiosity exemplifies how exciting unmanned space activity is, and how interested the public can be if NASA educates them.
Published on the Sept. 6, 2012 DiagnosticImaging.com website
By Whitney L.J. Howell
The final rule for Stage 2 of the Meaningful Use (MU) program, released last month, clarifies a few sticking points for the radiology industry, but some questions remain, say industry experts who are still digging through the specifics of the rule.
Still considered to be a move toward standards-based health information exchanges, the final rules for Stage 2 — released by CMS and the Office of the National Coordinator (ONC) set to take effect in 2014 —provide some additional clarity for how radiologists and hospitals should approach MU. But they’re little changed from the proposed versions. The similarities, some said, are surprising.
“It’s interesting that CMS’ final rule resembled the proposed rule as much as it did,” said Michael Peters, legislative and regulatory affairs director for the American College of Radiology (ACR), noting the short time between the publication of the proposed and final rules. “This was probably the result of an extremely quick rule-making that spent less time addressing stakeholders’ concerns.”
Individual providers and practices shouldn’t change their daily workflow and activities just yet, Peters said. The final rule, its requirements, and menu items, have not yet been completely analyzed.
However, it’s clear so far that the final rules offered additional guidance in three main areas: imaging accessibility, computerized physician order entry (CPOE), and hardship exemptions for meeting MU requirements. These areas have also been points of concern for the ACR.
According to Keith Dreyer, DO, chair of the ACR IT and Informatics Committee-Government Relations Subcommittee and radiology vice chair at Massachusetts General Hospital, the final rule guidance should make MU compliance easier for practicing radiologists. It combines certification criteria for eligible hospitals and eligible providers (EPs) in hospital settings with certified electronic health record (EHR) technology. The rule also impacts clinical quality measures.
“The clinical quality measures are better aligned with other quality incentive programs, making the overall process simple to achieve,” he said.
Fortunately, the final rule doesn’t require providers to store imaging results in an EHR with the ONC abandoning its proposal that images be available for download and transfer to third parties. Instead, they can offer a link to study results. In addition, CMS is only requiring 10 percent of images to be accessible this way instead of the 40 percent suggested in the proposed rule.
This change is a double-edge sword, Dreyer said. While it does relieve some of the pressure EPs felt regarding image accessibility, it also affects patients.
“It was disappointing to see the removal of the portion of the proposed MU objective requiring the ability for patients to view, download, and transmit their medical image data,” he said. “This was a common request of patients.”
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/meaningful-use/content/article/113619/2101122
Published in the April 2012 AAMC Reporter
By Whitney L.J. Howell
In late February, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released the proposed rules for Stage 2 of meaningful use and corresponding certification requirements. The rules introduce new measurements that doctors and hospitals will be required to meet to receive incentive payments for implementing electronic health records (EHRs).
The Stage 2 meaningful use rule is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was included in the 2009 American Recovery and Reinvestment Act. Under HITECH, hospitals and providers can receive Medicare and Medicaid incentive payments for adopting certified EHRs, using health IT in “meaningful” ways, and reporting clinical quality measures. CMS began making payments under the Stage 1 rule last year. With the law, Medicare hospitals and physicians who do not use health IT “meaningfully” will be penalized beginning in 2015. CMS has proposed criteria to determine which providers would be subject to this penalty. In most cases CMS plans to use a 2013 reporting period to identify proactively which providers are subject to a penalty, said Lori Mihalich-Levin, J.D., AAMC director of hospital and GME payment policies for health care affairs.
Industry leaders are still dissecting the details of the Stage 2 rule, but several key points already have emerged that will affect how providers approach meaningful use.
“CMS is obviously moving toward improved interoperability and information exchange,” Mihalich-Levin said. “However, there are some serious flaws with some of the proposed measures.”
The AAMC plans to submit its concerns to CMS and ONC by the May 7 deadline.
The biggest red flags in the new rule, Mihalich-Levin said, are proposals that require actions by third parties—in this case a patient—for the hospital or physician to meet the requirements. For example, hospitals and physicians must provide patients with online access to their health information. But in order to receive credit for meaningful use, at least 10 percent of patients must log on and actually view their records. An additional measure calls for at least 10 percent of patients to send their physician a secure, online message about their health care.
The problem, she said, is that there are no incentives for patients to comply, and providers cannot control whether patients feel comfortable with electronic communication, or have access to it.
“Hospitals can’t meet that requirement by implementing technology,” said Rod Piechowski, senior director of health information services at the Healthcare Information and Management Systems Society (HIMSS). “They must engage the patients on a different level, get them to take action, and recognize the value of the data. It’s a little bit out of their direct control.”
The proposed rule also increases the reporting requirements for many existing measures. For example, while Stage 1 called for 30 percent of medications to be ordered through computerized provider order entry, Stage 2 bumps the requirement to 60 percent of medications, and includes laboratory and radiology orders.
“This could be something that’s a minor change, but it will still require extra work to make sure we get the right groundwork in place,” said Tom Smith, chief information officer for Chicago’s NorthShore University HealthSystem. “It’s certainly a good idea to move away from writing down prescriptions on paper—ordering 100 percent of medications through e-prescribing would be great.”
Physicians and other clinicians who are eligible for the meaningful use incentives through Medicare also could benefit from the rule’s group reporting proposals. Rather than collecting quality measure data from each physician individually, beginning in 2014, CMS will allow doctors in group practices to report as a single unit.
“When you have a practice of hundreds or thousands of physicians, it’s logical to identify performance on clinical metrics as a group,” said Mary Patton Wheatley, AAMC manager of physician quality and payment policies. “Instead of a faculty practice trying to report measures for a variety of specialists and subspecialists (many of whom do not have relevant measures that can be reported through an EHR), the group reporting option allows the practice to focus on a single set of measures that makes sense for the practice as a whole and improves quality for the patient.”
Under the quality reporting requirement, beginning in 2014, hospitals would be able to choose which measures they report. While the element of choice is appealing, there are concerns about how this will ultimately impact the flow of measures used in other programs, including value-based purchasing.
It’s important to remember that any of these proposed measures could change in the final rule, which is expected this summer, Mihalich-Levin said. Until then, she recommended that institutions familiarize themselves with the various proposals. She added that after receiving feedback on the proposed Stage 1 requirements, CMS addressed many of the AAMC’s concerns in the final Stage 1 regulations. Over the next few months, the AAMC will review the proposed Stage 2 rules and encourage member institutions to provide feedback.
Smith agreed the proposed rule offers several benefits to teaching hospitals, but he cautioned that many of the meaningful use measures will require additional work from hospitals and physicians. Achieving certification or compliance, he said, will take time and resource investments to produce positive results.
According to Piechowski, hospitals that are just getting started on health IT will benefit from what others have learned.
“Hospitals should pay attention to what others have done, stay connected, get involved, and get ahead of the curve,” Piechowski said. “That is the best thing they can do. The people who are just getting in now are in an advantageous situation.”
Despite the challenges, health IT adoption is on the upswing. According to CMS, 35 percent of hospitals were using EHRs in 2011, compared with 16 percent in 2009. In addition, 85 percent of hospitals have said they plan to implement meaningful use and take advantage of the incentive payments by 2015. CMS will likely release proposed rules for Stage 3 of meaningful use in 2014 for implementation in 2016 and beyond.
To read article at original location: https://www.aamc.org/newsroom/reporter/april2012/279214/meaningful-use.html